Don’t worry, this psychiatrist won’t analyze you

I never know what people actually mean when they say that upon learning that I work as a psychiatrist.

I think they’re saying, “I hope you’re not going to spend our time together trying to discern my flaws.” Nobody wants people to seek out, highlight, and exploit their vulnerabilities and faults, so I can understand that. Of course, that’s not what psychiatrists do.

Anyway, let’s just take the statement at face value — that people hope that I won’t “analyze” them — regardless of what the underlying concern may be. Let’s also assume that when laypeople say “analyze,” they mean “do the things you do when you’re working as a psychiatrist.”

I cannot speak on behalf of all psychiatrists, but let me assure you: If you and I meet in a non-clinical context, I won’t “analyze” you. These are the reasons why:

1. It takes a lot of energy to “analyze” someone (a.k.a., “do the things psychiatrists do when they’re working”). When I’m working, these are the things I’m attending to:

What is the person saying? What words does he choose to express himself?

How is the person saying what she want to communicate? What is the tone of her voice? What nonverbal signals are present?

Is what this person is saying congruent with what this person is doing? What about his facial expressions and other physical movements?

What are the underlying or recurrent themes behind what this person is saying and doing?

What are the underlying assumptions the person has about himself? How are these underlying assumptions manifesting in what he says or does?

Is this person avoiding certain ideas or perspectives? If so, what are some possible reasons?

How did these ideas and behaviors come to be? Were they helpful or lifesaving in the past, but are now causing problems for the person? How do these thoughts and behaviors help this person now?

Is there something else going on that might explain this person’s thoughts and behaviors? Maybe this isn’t psychological; this might be a medical problem or related to substances (prescribed or not).

While attending to those tasks, I’m also:

Doing all the nonverbal stuff — often with intention — to let the person know that I’m listening

Saying things and doing nonverbal stuff to help the person feel both physically and psychologically safe in disclosing information to me. If I don’t receive accurate data from someone, I cannot help them as much as I possibly could.

Tracking the conversation and putting mental bookmarks in places to either revisit later during this dialogue or in the future (is this the right time to ask that question? how about now? should I phrase it differently now?)

Making mental notes of the important details I need to put in my note later

Gently (or more assertively, as the case may be sometimes) steering the conversation with questions and comments to make sure I get as much relevant information as possible, given the current circumstances (amount of time, condition of the individual, setting that we’re in)

All of these actions — not always visible, but definitely happening — require active listening, which means I shouldn’t space out. I need to be present and focused. We all know when someone isn’t paying attention to us.

When I do speak, I try to ensure that every sentence serves a purpose. Sometimes I ask questions when I want to make a statement; sometimes I say nothing, even though the individual may want me to fill the space with something (reassurance? confirmation of inaccurate ideas? answers that no one has?). I’m frequently generating hypotheses and testing them (is this person experiencing paranoia, or would he say more to another colleague? if this person intoxicated, or is there a medical issue present? does she actually want to die, or is she feeling powerless in the face of adversity?), while trying to show empathy and kindness. I don’t want to come across as an automated flow chart.

All of that — and more! — is happening when I’m doing clinical work. That takes a lot of energy. If I don’t have to use that energy, I won’t.

2. I don’t know how to “analyze” people. Upon hearing the word “psychiatry,” some people conjure up images of New Yorker cartoons with couches and stodgy psychiatrists sitting behind them. Psychiatrists and other mental health professionals usually go through extra training to learn psychoanalysis. The tradition of “analysis” goes back to Freud and, well, I’m not a fan.

Now, to be clear, there are some ideas that stem from psychoanalysis that I think have some value (for example, Malan’s text on psychodynamics offers interesting and, at times, useful perspectives on symptoms and behaviors). However, I don’t think everything boils down to love and work. Or sex and violence. I don’t think women are envious of men because men have penises. I think we all probably have an “unconscious” or “subconscious,” but I can’t prove it. I also don’t think the unconscious/subconscious is simply an arena where good and evil, depravity and virtue, and other polarities are constantly duking it out.

My disdain of psychoanalysis stems, in part, from cultural reasons. Freud and his buddies came from Western Europe (particularly Austria and Switzerland). America is a product of Western European ideas, and while I was born and raised in the US, I was raised by people who were not. I was inculcated with Confucian, Buddhist, and Taoist ideas. The psychologies of these traditions don’t refer to constructs like ids, egos, and superegos. They instead focus on filial piety, the importance of community over the individual, harmony as a paramount virtue, and the reality of suffering. These manifest more between, rather than within, individuals.

3. I’m not my job. Yes, I have been fortunate enough to go through medical and psychiatric training and do the work that I do, but that’s just one aspect of who I am. In my youth, psychiatry was not a part of my identity. If I am lucky enough to live long enough to retire, psychiatry will be something of my past. This is just a long phase of my life.

So, rest assured, I won’t analyze you. If I ask you questions, maybe I just want to get to know you.

Maria Yang is a psychiatrist who blogs at her self-titled site, Maria Yang, MD.

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients can share their insight and tell their stories.